Abstract
BackgroundAn obstetrical paradox is that maternal smoking is protective for the development of preeclampsia. However, there are no prior studies investigating the risk of preeclampsia in women who were exposed to tobacco smoking during their own fetal period. We aimed to study the subsequent risk of preeclampsia in women who were exposed to tobacco smoke in utero, using a national population-based register.MethodsData were obtained from the Medical Birth Register of Sweden for women who were born in 1982 (smoking data first recorded) or after, who had given birth to at least one child; 153 885 pregnancies were included.ResultsThe associations between intrauterine smoking exposure (three categories: non-smokers, 1–9 cigarettes/day [moderate exposure], and >9 cigarettes/day [heavy exposure]) and subsequent preeclampsia (n = 5721) were assessed using logistic regressions. In models adjusted for maternal age, parity and own smoking, the odds ratios (OR) for preeclampsia were 1.06 [95% CI: 0.99,1.13 for moderate intrauterine exposure, and 1.18, [95% CI: 1.10,1.27] for heavy exposure. Estimates were slightly strengthened in non-smoking women who experienced heavy intrauterine exposure (adjusted OR 1.24 [95% CI: 1.14,1.34]). Results were no longer statistically significant after adjustment for the woman’s own BMI, gestational age and birthweight Z-scores.ConclusionThese data revealed some evidence of a possible weak positive association between intrauterine smoking exposure and the risk of subsequent preeclampsia, however, results were not significant over all manifestations of preeclampsia and confounder adjustment. The increased risk might be mediated through exposed women’s own BMI or birthweight.
Highlights
Preeclampsia and other hypertensive disorders during pregnancy constitute a major cause of maternal and perinatal morbidity worldwide.[1]
In models adjusted for maternal age, parity and own smoking, the odds ratios (OR) for preeclampsia were 1.06 [95% confidence intervals (CI): 0.99,1.13 for moderate intrauterine exposure, and 1.18, [95% CI: 1.10,1.27] for heavy exposure
Estimates were slightly strengthened in non-smoking women who experienced heavy intrauterine exposure
Summary
Preeclampsia and other hypertensive disorders during pregnancy constitute a major cause of maternal and perinatal morbidity worldwide.[1]. Preeclampsia is generally considered to develop in two stages.[3, 4] The first stage is characterized by defects in implantation and formation of the placenta. As a result of an impaired blood perfusion, oxidative stress causes release of several factors that leak into the maternal circulation, where they cause inflammation and general endothelial damage, that eventually give rise to the clinical manifestations seen in stage two.[2, 4]. An obstetrical paradox is that maternal smoking is protective for the development of preeclampsia. There are no prior studies investigating the risk of preeclampsia in women who were exposed to tobacco smoking during their own fetal period. We aimed to study the subsequent risk of preeclampsia in women who were exposed to tobacco smoke in utero, using a national population-based register. University of Missouri, UNITED STATES Received: September 1, 2015 Accepted: November 13, 2015 Published: December 2, 2015
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